Author(s): Sasidharan PK


Our landmark studies on SLE had shown that hematological manifestations are the most common initial presentation; as high as 82% of the patients had hematological manifestations either alone or with another problem at presentation. In 76% of them hematological manifestation was the only problem at first presentation. SLE is thus more of a Hematological disorder, because it can present more often with hematological manifestations alone. Besides these, other patients of SLE with musculoskeletal, skin or other system involvement also have coexisting hematological problems. If they do not maintain a high index of suspicion and have a proper diagnostic approach, in those with hematological presentation, the diagnosis may be delayed or missed. Autoimmune hypothyroidism, which was one of the common coexisting abnormalities in these patients is not even included in the ACR criteria for diagnosis. In their patients, anemia was the commonest hematological abnormality and was due to multiple mechanisms. Incidentally in those who presented with hematological abnormalities they often did not have any rheumatological manifestations. Also, a significant number of patients did not satisfy the ACR criteria at the time of diagnosis, but they did satisfy it only on prolonged follow up. It is thus felt that the ACR criteria are weak and therefore needs revision. For that purpose, they have developed the “Kozhikode Criteria for SLE”. This new criterion was validated by another study and is being used for early diagnosis of SLE.

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